ABSTRACT
BACKGROUND: Studies have shown that arthroscopic single-bundle anterior cruciate ligament reconstruction can restore the forward stability of the knee joint, but the rotational stability of the knee joint and the matching degree with the patellofemoral joint are affected by the central position of the femoral and tibial tunnels. OBJECTIVE: To investigate the relationship between the location of different femoral tunnel centers and patellofemoral articulation and cartilage conditions in young and middle-aged patients with anterior cruciate ligament reconstruction, and to carry out the correlation analysis of patient study factors to further explore the location of the femoral tunnel with the least influence on the patellofemoral joint. METHODS: Seventy patients with anterior cruciate ligament rupture were diagnosed by preoperative MRI, physical examination and intraoperative arthroscopy. All patients were divided into quasi-isometric group and quasi-anatomical group according to the parity of random numbers. In the quasi-isometric group, a Kirschner needle was inserted 7 mm distal to the apex of the lateral wall of the intervertebral fossa using a femoral locator. In the quasi-anatomical group, the Kirschner needle was inserted at the lateral wall of the intercondylar fossa and at the foot print center of the original anterior cruciate ligament. The central coordinates of the femoral tunnel were evaluated on the near-far-front-rear plane based on a standardized grid system, while the central coordinates of the tibial tunnel was evaluated on the anterior-posterior-inner-outer plane, labeled as quadrant Y% and quadrant X%. By comparing the baseline data of patients in the two groups, the difference of lateral patellofemoral angle (LPFA), the difference of cartilage quantitative T2 value, and the correlation between various research factors, the surgical operators were further guided to carry out clinical practice. The implementation of the study protocol complied with the relevant ethical requirements of the First Affiliated Hospital of Anhui Medical University, and all patients signed an informed consent form prior to the participation in the trial. RESULTS AND CONCLUSION: There was no significant difference in baseline data between the two groups, but a significant difference in LPFA existed between the two groups, (0.57±0.33)° in the quasi-anatomical group vs. (1.55±0.36)° in the quasi-isometric group (P<0.001). The T2 values of medial patella, lateral patella and trochlear cartilage in the quasi-anatomical group were all smaller than the corresponding values of the quasi-isometric group. Quadrant X% had a significant negative correlation with LPFA difference (R=-0.664, P<0.01). Quadrant Y% was positively correlated with LPFA difference (R=0.804, P<0.01). The difference of LPFA was significantly positively correlated with T2 values of trochlear and patellar outer cartilage (R=0.651, 0.655, P<0.01). T2 values of trochlea and lateral patella cartilage were negatively correlated with postoperative Lysholm score (R=-0.505, -0.529, P<0.01). Quadrant Y% was highly correlated with T2 value of lateral patella (R=0.825, P<0.01), and significantly correlated with T2 value of trochlear cartilage (R=0.798, P<0.01). Quadrant X% was negatively correlated with T2 values of lateral patella and pulley cartilage (R=-0.639, -0.657, P<0.01). By exploring the change of the patellofemoral joint at early stage after single-bundle anterior cruciate ligament reconstruction, we found that the quasi-anatomical reconstruction relative to the quasi-isometric reconstruction requires less patellofemoral articular cartilage degeneration and smaller patellar tilt angle. Therefore, the surgeon is required to local the center point of the femoral tunnel as far as possible at the quasi-anatomical position, thereby minimizing the degeneration of the patellofemoral joint.
ABSTRACT
BACKGROUND: We investigated whether the patellar tilt angle influences the maximum knee flexion after total knee arthroplasty (TKA) performed by using a posterior cruciate ligament-substituting (PS) fixed-bearing prosthesis in patients with relatively loose or tight flexion gap. METHODS: In this prospective cohort study, we followed up 169 patients for at least 2 years after TKA using PS fixed-bearing prosthesis. The patients were divided into two groups according to the flexion gap value—calculated by subtracting the thickness of the final bearing from the flexion gap measured intraoperatively under 200-cN·m force after patellar reduction and insertion of the final femoral and tibial components—into a relatively tight group (group T; 3–6.5 mm) and a relatively loose group (group L; 7–11 mm). Patellar tilt angles and maximum non–weight-bearing active knee flexion angles were assessed postoperatively. Group T was further divided into subgroup Tn if the patellar tilt angle was < 5° and subgroup Tw if the angle was ≥ 5°. Pearson correlation test was used for the correlation analysis of the flexion gap, patellar tilt angle, and postoperative flexion range. RESULTS: The mean postoperative flexion was 137.3° in group T and 137.5° in group L. The mean patellar tilt angle was 6.5° in group T and 6.9° in group L. In group T, a strong negative correlation (r = −0.78, p < 0.05) was observed between the patellar tilt and postoperative flexion range. However, further analysis revealed that only the subgroup Tw showed a strong negative correlation (r = −0.76, p < 0.05). Significant correlations were not found in the subgroup Tn and group L. CONCLUSIONS: In TKA where a relatively tight flexion gap (≤ 6.5 mm) is created because of concerns about postoperative flexion instability due to a loose flexion gap, the patellar tilt angle should be < 5° for maximal postoperative knee flexion.
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Cohort Studies , Knee , Prospective Studies , Prostheses and Implants , Range of Motion, ArticularABSTRACT
La disfunción patelofemoral (DPF) es causa frecuente de consulta clínica y se refiere, a grandes rasgos, a una patología en la cual la patela falla en la correcta entrada en la tróclea. Es un tema en el que la terminología suele ser ambigua y confusa, debido entre otras cosas a la discrepancia entre la clínica y la imaginología. Además, la etiología de la DPF es multifactorial, incluyendo factores anatómicos locales, rotacionales y dinámicos, no existiendo tampoco claridad acerca de su real influencia. Desde el punto de vista imaginológico, existen innumerables publicaciones, con diferentes clasificaciones y mediciones descritas para las distintas técnicas, sin embargo, no hay un consenso amplio en relación a cuáles son las alteraciones anatómicas o los valores normales que el reporte imaginológico debiera incluir. Se realiza una revisión de la literatura existente y se propone para los pacientes con DPF, un estudio radiológico que considera los factores etiológicos anatómicos y un estudio tomográfico de segunda línea, que incluye estudio rotacional de extremidades inferiores, sistematizando las mediciones y puntos relevantes en una plantilla de informe.
Patellofemoral dysfunction (PFD) is a common cause for medical consultation and in a broad sense it refers to a condition in which the patella fails to engage securely in the trochlear groove. This is a topic in which terminology is often ambiguous and confusing due, inter alia, to the discrepancy between symptomatology, imaging findings and physical examination. In addition, PFD has a multifactorial etiology that includes local anatomical, rotational and dynamic factors, with no certainty about its real influence. From the imaging point of view, there are countless publications proposing different classifications and measurements obtained trough different imaging techniques; however, there is no consensus regarding what are the anatomical alterations or the normal values that imaging reports should include. A review of the existing literature is performed and we propose that patients with PFD should undergo both a radiological study comprising etiologic and anatomic factors and a second-line tomographic exploration including lower extremity rotational profiles. From the radiological and clinical viewpoints, relevant issues to be considered as well as assessments performed should be systematized and recorded in a report sheet.
Subject(s)
Humans , Knee Joint/physiopathology , Knee Joint , Biomechanical Phenomena , Patella/physiopathology , Patella , Knee Joint/pathology , Joint Instability , Patellar Dislocation , Rotation , Patella/pathology , Tomography, X-Ray Computed , Torsion, Mechanical , Severity of Illness IndexABSTRACT
PURPOSE: This study was performed to determine new criteria for performing lateral retinacular release (LRR) without having a detrimental effect on patellar tracking. MATERIALS AND METHODS: For 17 patients who underwent bilateral TKAs, LRR was not performed at one side (A) due to improvement of patellar tracking after deflation of tourniquet although maltracking existed with the inflation of tourniquet. At the other side (B), LRR was not performed either because patellar tracking improved with one stich method although maltracking existed regardless of tourniquet status. We measured the lateral patellar tilt angle (LPTA) of each side inthose 17 patients after 1 year after TKAs and compared them. We also surveyed the incidence of LRR in 225 primary TKAs with the staged method of patellar tracking evaluation during the same period. RESULTS: The average LPTA was 3.4degrees at side (A) and 4.6degrees at side (B) respectively. There was no significant difference in LPTA between side (A) and side (B) (p=0.337). From the survey for incidence of LRR in 225 primary TKAs during the same period, LRR was not required in 19% of patients showing good patellar tracking with inflation of tourniquet, 58% of patients showing improved patellar tracking after deflation of tourniquet and 21% of patients showing improved patellar tracking by one stitch method regardless of tourniquet status. Consequently, only 2% of patients required LRR in primary TKA. CONCLUSION: One stitch method under the deflation of tourniquet in evaluating process of patellar tracking during primary TKAs is supposed to be very effective and to reduce the incidence of LRR to only 2% without influencing the LPTA.
Subject(s)
Humans , Incidence , Inflation, Economic , Knee , Thumb , Tourniquets , Track and FieldABSTRACT
PURPOSE: The pattern of patellar tracking is changed depending upon whether a tourniquet is operating or not. This study was performed to suggest the criteria of lateral retinacular release(LRR) in total knee arthroplasty(TKA) based on the lateral patellar tilt angle(LPTA). MATERIALS AND METHODS: In study 1, the LPTA was compared in 24 bilateral TKAs, one side was required LRR and performed LRR, but not required and not done LRR on the other side according to the patellar tracking status in deflating tourniquet. In the second prospective study, we performed LRR one side and not the other side intentionally in all 11 patients' knees(22 knees) those who were same situations that the patellar tracking was not good under the condition of operating tourniquet but tracking was improved after deflation of tourniquet. We compared LPTA in both studies with paired t-test of SPSS 11.0. RESULTS: The LPTA was average 4.86 degrees on the side of performed LRR and 4.83 degrees on the other side in 24 patients. There was no significant difference of LPTA between them(p=0.952) in study 1. And the LPTA was average 5.18 degrees on the side of underwent LRR based on the condition of operating tourniquet, 5.45 degree on other not LRR side knee. There were also no significant difference between them(p=0.829) in study 2. CONCLUSION: The incidence of LRR will be reduced with no detrimental effect on lateral patellar tilt angle when making decision of LRR based on the patellar tracking status in deflating tourniquet.